BLOG: Fact vs. Myth -Motivational Interviewing is basic counseling

Guest Blogger: John Gilbert

Motivational Interviewing is basic counseling. I can get the outcomes associated with Motivational Interviewing in the research studies if I learn about and use O.A.R.S. (Open-ended questions, Affirmations, Reflections, and Summaries).

Answer: MYTH!

Nuance:

It’s true that providing Empathy with these skills can improve clinical outcomes when usual care does not include much Empathy (see here). And yes, O.A.R.S.  are core skills within MI. However, the…

…Myth…

is that MI can be learned by PRIMARILY focusing our education on these core skills via a book or multiple MI trainings and be “Competent” or “Proficient” in Motivational Interviewing due to this. Many people at various clinics, practices, etc. then cite the research of MI on their websites or espouse that they utilize MI.

The research with learning Motivational Interviewing does not support this (see below); instead, it shows that most people, most of the time need practice and feedback to learn Motivational Interviewing, just like other complex skill sets. However, it’s to conclude that “I am above average” when not in a depressed state of mind, especially with something we’ve learned about or practiced much. This invites you to think,

“How much do I really want to not just learn about MI, but also actually embody the Motivational Interviewing Intentions and Strategies in ways that are the most potently empowering to most people most of the time in the most efficient manner?”

Only you can decide this, and most don’t decide to engage in this process called fidelity Motivational Interviewing. If you want to further grow in your MI knowledge, skills, and abilities, then receiving feedback with an MI fidelity tool has been shown to help with that far more than reading about MI or going to multiple workshops (yes, even advanced workshops). Additionally, other programs (be it graduate school or professional ongoing education) out there that mention MI briefly as being utilized, but that does not seek to implement an instrument of fidelity MI that includes feedback will likely not achieve the results associated with MI and therefore may not transform the person’s life in the way that the potency of an MI fidelity conversation would.

The challenge is, that like with many skills, without intentional mindfulness and practice, you don’t see outcomes.  Let’s say you want to learn a foreign language.  You might be able to sit in the classroom (or zoom classroom) and learn what words correlate to words in your native tongue, but without dedicated time to practice you don’t necessarily learn the skill set. So those that often are learning a new language, or new skills take time to intentionally practice.  Whether that practice is for 5 minutes or 45, being intentional with learning is the key to learning a skill set, particularly with feedback that’s reliable when possible.

Data:

• “And to this counsel of “try it” we add the reminder that developing skill in MI takes time. Hasty efforts with minimal training often fail to produce good results. Low-quality MI practice might be likened to half doses of a vaccine or antibiotic: the right idea but insufficient strength.” (Miller & Rollnick, 2013)

• “Failure to establish treatment fidelity can result in unanticipated, non-significant findings that are erroneously attributed to problems with the intervention itself as opposed to its poor delivery (Resnicow et al., 2006).” (Robbins et al., 2012)

• “Although many studies have found MI to be effective for improving health behaviors, delivery of the treatment often varies among therapists and across samples (Carroll et al., 2006; Madson & Campbell, 2006; McCambridge, Day, Thomas, & Strang, 2011). This is especially critical as therapist fidelity to MI techniques and style has been found to predict client behavioral outcomes (Cox et al., 2011; McCambridge et al., 2011; Moyers, Martin, Houck, Christopher, & Tonigan, 2009).” (Koken et al., 2012)

• “The MI research is well-aligned with the research and best practices in the field of learning and organization development, including the American Society of Training and Development (ASTD), that emphasize the limitations of legacy stand-alone training programs that do not provide sufficient attention to competency development and assessment, transfer of new learning to the job, and return on investment (ROI) of training costs^[8].”(Butterworth & Andersen, 2011)

• “Our analysis suggests that when a health professional encounters individuals with low motivation for change, this increases the complexity of the intervention and several interactional dilemmas may occur that make it difficult to follow basic MI principles.”
  • Codern-Bové N, Pujol-Ribera E, Pla M, et al. Motivational interviewing interactions and the primary health care challenges presented by smokers with low motivation to stop smoking: a conversation analysis. BMC Public Health. 2014;14:1225. doi:10.1186/1471-2458-14-1225.

• “…MI is not a trick or a technique that is easily learned and mastered. It involves the conscious and disciplined use of specific communication principles and strategies to evoke the person’s own motivations for change.” (Miller & Rollnick, 2009)
• Miller, W.R. & Rollnick, S. (2009) Ten things that Motivational Interviewing is Not Behavioural and Cognitive Psychotherapy, 2009, 37, 129-140.
  
  
• “An unfortunate consequence of such rapid dissemination is that misunderstandings of this method easily arise, and the quality of service delivery can suffer. In some ways MI is simple, but mastering it is neither quick nor easy. We have likened the process to that of learning to play a musical instrument or a skillful sport. Reading and lectures can take you a certain distance, but ultimately it is practice that shapes and improves skill in MI. As in music or sport, it helps to receive good feedback and coaching along the way.”
  • Rosengren, D. B. (2009). Building motivational interviewing skills: A practitioner workbook. New York: Guilford Press. P. ix.

• “…this has not been proved in our study, possibly due to the satisfactory baseline scores on such features. There are several studies that point out that basic workshops do not produce sufficient competence in MI and that it takes much more practice in real-life situations (rather than role-playing). This implies that trainees may need longer-term continuing supervision and support than previously recognized [31].”
  • “…Coaching and reviewing sessions were not demanded for all professionals and, as some research has demonstrated, postworkshop inputs such as feedback and coaching assessing performance after training are usually needed to sustain training gains over time [32].”
    • Pilar Lusilla-Palacios and Carmina Castellano-Tejedor, “Training a Spinal Cord Injury Rehabilitation Team in Motivational Interviewing,” Rehabilitation Research and Practice, vol. 2015, Article ID 358151, 7 pages, 2015. doi:10.1155/2015/358151

• “The Majority (66% (2/3) out of the 12) of systematic reviews of MI in health care, which included meta-analyses…
  • …have the Minority (less than 50%) of their studies providing treatment fidelity information.
    • Only 4 of the 12 studies (33%) have the majority of studies reporting fidelity, and, of those studies that have at least 50%, the percentage of studies don’t go far beyond 50% (55-64%), except for one study that had 71% reporting fidelity.” (McKenzie et al., 2015)
      • “Further research may benefit from a greater focus on clinician proficiency, and a greater emphasis on the effectiveness of MI when delivered by a range of clinicians. Future research also needs to include treatment fidelity measures [37] to ensure the intervention being studied is indeed MI.” (McKenzie et al., 2015)
        • MCKENZIE, Kylie J.; PIERCE, David; GUNN, Jane M.. A systematic review of motivational interviewing in healthcare: the potential of motivational interviewing to address the lifestyle factors relevant to multimorbidity. Journal of Comorbidity, [S.l.], v. 5, n. 1, p. 162-174, dec. 2015. ISSN 2235-042X. Available at: